Provider Demographics
NPI:1235115619
Name:GALLOWAY, PAULA ELIZABETH (DO)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:ELIZABETH
Last Name:GALLOWAY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:ELIZABETH
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:66 HOSPITAL PLZ
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WESTON
Mailing Address - State:WV
Mailing Address - Zip Code:26452-8558
Mailing Address - Country:US
Mailing Address - Phone:304-269-6004
Mailing Address - Fax:304-269-6026
Practice Address - Street 1:66 HOSPITAL PLZ
Practice Address - Street 2:SUITE 102
Practice Address - City:WESTON
Practice Address - State:WV
Practice Address - Zip Code:26452-8552
Practice Address - Country:US
Practice Address - Phone:304-269-6004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007682208600000X
TNDO0000001955208600000X
AK6118208600000X
WV2666208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1507607Medicaid
NC5910329Medicaid
NC5910329Medicaid